Caring for Women in Labor at the Height of Liberia’s Ebola Crisis: The ELWA Hospital Experience

  • Rick SacraEmail author
  • John Fankhauser
Part of the Global Maternal and Child Health book series (GMCH)


The Ebola epidemic of 2013–2015 caused over 11,000 deaths in Guinea, Liberia, and Sierra Leone. During the crisis, hospitals ceased operations or limited the care they provided. Pregnant women needing assistance with complicated deliveries had few alternatives. The Eternal Love Winning Africa (ELWA) Hospital in Liberia was one health facility which experienced a period of closure, reduction of services, and health care personnel becoming ill with Ebola Virus Disease. In this phenomenological study, we initially present data from ELWA Hospital’s Obstetrics Department during a 3-month period at the peak of Liberia’s Ebola epidemic (July to September 2014). We then present the stories of two physicians as they cared for patients and interacted with staff during the crisis. Through these vignettes, we learn of the barriers to care that patients experienced, as well as the manner that relationships between health care providers and patients were impacted by the Ebola outbreak and its sequelae. The authors then discuss their reflections on the impact which Ebola had on the doctor-patient relationship. Both doctors and patients approached interactions differently due to perceived risks. By examining the doctor-patient relationship through professional, spiritual, and philosophical lenses, resources are identified to counteract the forces threatening that relationship.


Ebola virus disease Pregnancy Obstetrics Doctor-patient relationship ELWA Hospital Risk Stillbirth Maternal death Family medicine Liberia Ebola treatment unit Hospital Health care provider Infant death Nosocomial infection Infection control Infrastructure SIM Midwives 


  1. Akerlund, E., Prescott, J., & Tampellini, L. (2015). Shedding of Ebola virus in an asymptomatic pregnant woman. New England Journal of Medicine, 372(25), 2467–2469. Retrieved December 14, 2017, from Scholar
  2. Bryan, J. E. (1968). The role of the family physician in America's developing medical care program: A report and commentary. St. Louis: Warren H. Green, Inc.Google Scholar
  3. Buber, M. (2007). Dialogue. In R. Craig & H. Muller (Eds.), Theorizing communication readings across traditions (pp. 225–237). Los Angeles: Sage.Google Scholar
  4. Centers for Disease Control and Prevention and World Health Organization. (1998). Infection control for viral hemorrhagic fevers in the African health care setting. Retrieved December 1, 2017, from
  5. Ekyinabah, E. K., Okiror, D., Ssentamu, J. V., Babua, C., & Njoh, J. N. (2016). Conditions associated with mortality among hospitalized patients in the medical ward of the John F Kennedy Medical Center-Monrovia, Liberia. Monrovia: Liberia College of Physicians and Surgeons Scientific Session.Google Scholar
  6. Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Noonday Press.Google Scholar
  7. Lopez, K. A., & Willis, D. G. (2004). Descriptive versus interpretive phenomenology: Their contributions to nursing knowledge. Qualitative Health Research, 14(5), 726–735.CrossRefGoogle Scholar
  8. Ly, J., Sthananthan, V., Griffiths, T., Kanjee, Z., Kenny, A., Gordon, N., et al. (2016). Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: Analysis from a cross-sectional, population-based household survey. PLoS Medicine. Retrieved November 15, 2017, from
  9. Medecins Sans Frontieres. (2014). Field notes: The largest Ebola management centre ever built. MSF’s ELWA 3, Monrovia, Liberia. Retrieved December 1, 2017, from
  10. Mobula, L. (2014). Courage is not the absence of fear: Responding to the Ebola outbreak in Liberia. Global Health: Science & Practice, 2(4), 487–489. Retrieved February 25, 2018, from Scholar
  11. Nyenswah, T.G., Westercamp, M., Kamali, A.A., Qin, J., Zielinski-Gutierrez, E., et al. (2014). Evidence for declining numbers of Ebola cases-Montserrado County, Liberia, June–October 2014. Morbidity and Mortality Weekly Report, 63, 1–5n. Retrieved December 12, 2017, from
  12. Oduyebo, T., Pineda, D., Lamin, M., Leung, A., Corbett, C., & Jamieson, D. (2015). A pregnant patient with Ebola virus disease. Obstetrics and Gynecology, 126(6), 1273–1275.CrossRefGoogle Scholar
  13. Parpia, A., Ndeffo-Mbah, M., Wenzel, N., & Galvani, A. (2016). Effects of response to 2014-2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging Infectious Diseases, 22(3), 433–441 Retrieved November 18, 2017, from Scholar
  14. Penfield, J. A. (1981). Quoting behavior in Igbo society. Research in African Literatures, 12(3), 309–337.Google Scholar
  15. Smith, J. A. (1996). Beyond the divide between cognition and discourse: Using interpretive phenomenological analysis in health psychology. Psychology & Health, 11(2), 261–271. Scholar
  16. Solomon, M. (1985). The rhetoric of dehumanization: An analysis of medical reports of the Tuskegee syphilis project. Western Journal of Speech Communication, 49(4), 233–247.CrossRefGoogle Scholar
  17. Spencer, C. (2015). Having and fighting Ebola — Public health lessons from a clinician turned patient. New England Journal of Medicine, 372(12), 1089–1091 Retrieved December 14, 2017, Scholar
  18. Sriphanlop, P., Jandorf, L., Kairouz, C., Thelemague, L., Shankar, H., & Perumalswami, P. (2014). Factors related to hepatitis B screening among Africans in New York City. American Journal of Health Behavior, 38(5), 745–754. Scholar
  19. Strong, A., & Schwartz, D. A. (2016). Sociocultural aspects of risk to pregnant women during the 2013-2015 multinational Ebola virus outbreak in West Africa. Health Care for Women International, 37(8), 922–942.CrossRefGoogle Scholar
  20. Suk, J., Jimenez, A., Kourouma, M., Derrough, T., Balde, M., Honomou, P., et al. (2016). Post-Ebola measles outbreak in Lola, Guinea, January-June 2015. Emerging Infectious Diseases, 22(6), 1106–1108 Retrieved November 13, 2017, from Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Massachusetts Medical SchoolWorcesterUSA
  2. 2.ELWA HospitalPaynesville, MonroviaLiberia
  3. 3.David Geffen School of Medicine at UCLALos AngelesUSA

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